Seizure the Day: Living a Happy Life with Illness

By Brian Orend

This guide to being happy while living with chronic illness and conditions is grounded in scientific research

• Language: English
• Publisher: Freehand Books
• Release date: Jan 1, 2019
• ISBN: 9781988298429

Brian Orend

Brian Orend is a professor of philosophy at the University of Waterloo in Canada. He is the author of six books, including the bestselling The Morality of War, one of the most widely-used books on the ethics of war and peace. He is best-known for his work on human rights and post-war justice. He has a Ph.D. from Columbia University in New York City, has been Distinguished Visiting Professor of Human Rights at Lund University in Sweden, and has lectured around the world and around the web. Brian has epilepsy owing to a brain tumour, which has motivated his research into happiness in spite of illness.

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Cover: Seizure the day: Living a happy life with illness, by Brian Orend.

Living a Happy Life with Illness

Smiley face.

Seizure

the

Day

BRIAN OREND

Logo: Freehand Books.

© Brian Orend 2018

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, graphic, electronic, or mechanical — including photocopying, recording, taping, or through the use of information storage and retrieval systems — without prior written permission of the publisher or, in the case of photocopying or other reprographic copying, a licence from the Canadian Copyright Licensing Agency (Access Copyright), One Yonge Street, Suite 800, Toronto, Ontario, Canada, M5E 1E5.

Freehand Books acknowledges the financial support for its publishing program provided by the Alberta Media Fund, and by the Government of Canada through the Canada Book Fund.

Logo: Government of Alberta. Logo: Government of Canada.

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Library and Archives Canada Cataloguing in Publication

Orend, Brian, 1971–, author

Seizure the day : living a happy life with illness / Brian Orend.

Issued in print and electronic formats.

ISBN 978-1-988298-41-2 (softcover).

ISBN 978-1-988298-42-9 (epub).

ISBN 978-1-988298-43-6 (pdf)

1. Happiness.

2. Chronically ill—Mental health.

3. Chronically ill—Life skill guides.

4. Chronic diseases—Psychological aspects.

I. Title.

BF575.H27O74 2019    152.4’2    C2018-905613-4    C2018-905614-2

Edited by Andrew Wilmot

Book design by Natalie Olsen, Kisscut Design

Cover image © go2 / photocase.com

Cartoons on page 353–354 with permission of www.cartoonstock.com

Author photo by Terry Manzo, terrymanzo.com

CONTENTS

Introduction

Section 1

Happiness in General, and Pleasure in Particular

1    Can Happiness Actually be Pursued?

2    Why Should Happiness be a Goal?

3    Pleasure

Section 2

The External Goods

4    Work and Income

5    Social Institutions

6    Interpersonal Relationships

7    The Body

Section 3

The Internal Goods

8    Mental Hygiene

9    Emotional Hygiene

10   Moral Character

Notes

Acknowledgements

Cover

Title Page

Copyright Page

Contents

Dedication

Introduction

Section 1: Happiness in General, and Pleasure in Particular

1 Can Happiness Actually be Pursued?

2 Why Should Happiness be a Goal?

3 Pleasure

Section 2: The External Goods

4 Work and Income

5 Social Institutions

6 Interpersonal Relationships

7 The Body

Section 3: The Internal Goods

8 Mental Hygiene

9 Emotional Hygiene

10 Moral Character

Notes

Acknowledgements

About the Author

Guide

Cover

Title Page

Copyright Page

Contents

Dedication

Start of Content

Notes

Acknowledgements

About the Author

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Dedicated with love to my family: Mom;

Barry; Tissums; and my beautiful boy, Sam.

INTRODUCTION

Given his violent life and brutal murder—viciously stabbed over twenty times by a group of enraged Roman senators—you might not think Julius Caesar has much to teach us about happiness. But the one-time dictator of ancient Rome gave us two legendary quotes that resonate to this day.

The first is the much-repeated opening line from his book The Gallic War, which details Caesar’s military campaigns—and ultimate victory—over the various tribes of primitive France (then called Gaul), resulting in France becoming absorbed into the Roman Empire. The line in question, translated, reads: All Gaul is divided into three parts. Caesar proceeded to show how he came to understand each of the three regions of France—the geography and the different tribes therein—and how he proceeded to crush them one-by-one, bringing them under Roman control and changing European history forever.¹

The second quote is Caesar’s famous declaration "Veni, Vidi, Vici"—I came, I saw, I conquered. He wrote this in a private letter to a friend, after achieving a swift and decisive victory over one of Rome’s lesser but still pesky rivals, Pharnaces II of Turkey. The declaration is typical of Caesar’s tough-minded and fast-moving writing style, and presumably reflects the man’s unsentimental, action-focused, and ambitious character.²

Like Gaul, happiness is thought to have three parts (each with several sub-components). This piece of observed wisdom comes from the ancient Greek philosopher Aristotle, who predated Caesar by 300 years. To this day, Aristotle remains one of the most systematic and sensible thinkers about human well-being and joyous flourishing. Aristotle argued that the three major components of happiness are: 1) pleasure; 2) external goods, such as friendship and membership in a good society; and 3) internal goods, such as having correct beliefs, well-governed emotions, and an upstanding moral character.³ We can offer the following overview:

FIG 1 THE THREE MAJOR PARTS OF HUMAN HAPPINESS

Infographic showing the three major parts of human happiness: pleasure, the external goods, and the internal goods.

We shall, throughout this book, explore these three parts (and their many fascinating sub-components) in detail: what they mean in our day and age, and what the latest expert research suggests about each of them. We shall also consider what Aristotle missed, or was mistaken about, and how best to view the relationship between these elements of happiness.

Of course, we’re not interested in merely understanding happiness. Happiness is something universally desired. Aristotle maintained that happiness alone is the one intrinsic human good or goal, with all others—the pursuits of money, power, love, and fame—being, by contrast, instrumental. Happiness stands as the one goal whose pursuit requires no explanation; it is the reason why, Aristotle believed, we do anything at all.⁴ Again: we don’t just want to read and think about happiness; we actually want to live happy lives and enjoy the experience of being happy people. We don’t simply wish to understand happiness; we want, truly, to grasp its component parts, to master and incorporate them thoroughly into our lives. Much as Caesar defeated his rivals and realized his goals, we too wish to come toward happiness, to see it for ourselves, and finally to conquer it and make it our own.

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This isn’t just one more book about happiness, though. There exist many terrific studies to which we will refer, ranging all the way from Aristotle’s Nicomachean Ethics (circa 350 BC) to Sonja Lyubomirsky’s The How of Happiness (2007) and beyond. ⁵ Yet, while we must, unavoidably, begin by talking about happiness in general, the particular focus and special concern of this book—as the title indicates—is how people with chronic diseases, disorders, injuries, or challenges can improve their experience of happiness. In my view, too many happiness studies lack deeply considered and helpful advice for those wanting to live happier lives while being forced to confront serious obstacles brought on by chronic illness and conditions. Three quick examples:

•  One of the most potent threats to a person’s happiness is prolonged unemployment. People suffering from chronic conditions are much more likely to be unemployed. Thus, they are more vulnerable to unhappiness and, indeed, to enduring unhappiness of the kind that can slide into clinical depression. ⁶

•  Evidence suggests that people with chronic conditions become more introverted as a result of their condition(s). (The proverbial wounded animal, hiding alone at the back of the cave.) The happiness problem with this is that, other things being equal, the more introverted you become, the less satisfied you report yourself with life. ⁷

•  As Daniel Nettle says, in Happiness: The Science Behind Your Smile, there are two personality traits, or dimensions, which seem most important when it comes to the level of happiness people report. The first is the degree to which people are extroverted over introverted. The second is the degree to which people are well-adjusted over neurotic—a term that, though often a pejorative, is here used in a purely technical sense to show how people experience anxiety and difficulty when confronted by certain tasks (whether such tasks be daily and routine, or novel and exceptional). It stands to reason that people with chronic conditions—because of those very conditions—are going to have a harder time managing tasks than the average, unafflicted person, and probably also experience more anxiety in general, both because of that and because the condition itself gives them yet one more thing to be anxious about. ⁸

Note how relevant these last two observations are. If Nettle is correct—and introversion/extroversion alongside neurotic/well-adjusted are the two most salient personality dimensions factoring into someone’s happiness—then it would seem as though people struggling with a chronic condition (since they are more likely to be both more introverted and more neurotic) do indeed confront substantial obstacles along the road to happiness.

It’s not merely that those with chronic conditions face such complications; it’s that the advice required to deal with such obstacles and to augment their happiness will differ from the average, or unafflicted person. It’s simply not enough to say, for example, that one should try to be more social. In addition to issues of willing and wanting such, those afflicted—because of their conditions—are more likely than others to be introverted and to not want to behave in an extroverted way. Their conditions may cause them pain, or hinder their functioning (even something as simple as their ability to stand for long stretches of time), or cause them to exhibit behaviour or traits not accepted or understood by unafflicted people (like having a seizure). These things make it objectively more challenging for such people to get up and be more social. Thus, offering good happiness advice that is sensitive to such challenges is the main goal of this book.

As I see it, the audience for this book resides between two extremes. On the one hand, there are individuals with severe mental health problems—those suffering from debilitating clinical depression, for example. This is not my primary audience, and there are many excellent books offering help and advice for such people, who usually require some kind of expert medical intervention. ⁹ Likewise, there are those with severe physical health problems, such as people who are bed-ridden with inescapable and searing chronic pain, or those who’ve suffered catastrophic injuries, or face life-threatening diagnoses and, consequently, brutal prescribed treatments. I do not pretend to know what to tell such people, as they too require expert medical intervention—individually apprised of the details of their situation—to try to help them manage their realities.

In between these extremes is another—I think, very large—group of people. Those who do have a chronic condition that hinders their ability to function normally, often (or at times) in a substantial way. However, they are neither bed-ridden nor plagued by inescapable pain. Nor are they suicidal, or otherwise suffering so badly from a mental health problem that they cannot function meaningfully or at all. They can function, just not to an average, expected human capacity (in some specific regard). They are ill or injured, yet not ruinously so. They are healthy and capable enough to do many of the things that average people do, and, like the average person, are keenly interested in happiness and in becoming, if not the happiest possible person they can be, at least measurably happier.* They hope for something better, and are confident they can experience such, if only they receive decent advice calibrated to their circumstances. I hesitate to guess just how large this group of people is (much less to list all the relevant chronic conditions that might fall under this heading), but my hunch is that—especially in our ageing society—it’s substantial. As such, while the majority of happiness books are for anyone and everyone, they fail to speak fully to the special interests and needs of this sizable group of people. As with everything else, it is also true that, in regards to happiness, one size does NOT fit all.

---

So, what chronic condition do I have that gives me insight into this group of people and, so to speak, the right and interest to address them this way? If I have written such a book, surely it must be because of some personal reason—some journey I have made from which I have gained experience. Indeed, I have epilepsy, caused by a brain tumour. ¹⁰ (Incidentally, most historians agree that Julius Caesar probably had epilepsy, and that it ran throughout his extended family, the so-called Julio-Claudians.) My own tumour-based epilepsy has given me more seizures than I can count—the majority of which have occurred in broad daylight out in public, and several of which have been so severe that I have been hospitalized, and utterly incapacitated, for days on end.

Here’s how I became interested in the subject of happiness.

It was November 2001, just two months after the terrorist attacks of 9/11. I was a thirty-year-old philosophy professor lecturing to a group of twenty-year-old undergraduates at the University of Waterloo in Ontario, Canada. Feeling fine, and without any history of health problems, I suddenly keeled over right in front of my class, losing consciousness and smacking my spine against the blackboard ledge as I fell backwards … then sidewards … then down onto the floor. Some thought I’d had a heart attack and had just dropped dead, right before their tender eyes. My memory of the next few days is completely gone: near-total memory loss in and around the event is a common side effect of seizures. Even after being discharged, I still felt like I had been hit by a train—when you have a grand mal, or major seizure, your muscles can contract so severely, and so quickly, that it can later feel (as inflammation and repair kick in) like you have been completely clobbered. Upon my discharge, after several days’ hospitalization that included a glamorous stay in the ICU, I could no longer legally drive a vehicle. It was a mystery as to why I had suffered a seizure in the first place—my vital signs had eventually returned to normal—and so testing was ordered.

It’s routine that, upon suffering a grand mal seizure, a Magnetic Resonance Image (MRI) of the brain is ordered to look specifically for evidence of stroke and/or tumour. Following my release from the ICU, I ventured to a larger hospital in another city to receive this, noting with minor irony that it would be the very hospital in which I was born. So, I got my MRI and, as usual, was told that, should anything untoward or suspicious appear in the image, my doctors would all be notified. Well, no one ever called; and so, my doctors proceeded on the assumption that my brain was clear and healthy, and that there was no brain-cause for the seizure. All eyes and medical attention then turned to my heart, and assumption was made that it must be cardiac in nature, such as an irregular heartbeat.

What followed was a quick and deep descent into prolonged unhappiness. In reality, the seizures had no cardiac cause, yet for years—years—I was treated as if I’d had a heart problem. I took countless prescribed drugs, and even underwent several surgical procedures. I burned through specialist after specialist, both cardiologists and neurologists. (One memorable visit was to a cardiologist who, supposedly, was Ontario’s Very Best heart doctor. After hearing my story, he loudly proclaimed: You need someone at the top of his game! Imagine this being declared by someone wearing a white coat and stethoscope, and otherwise looking and sounding just like Will Ferrell in Anchorman.) I kept on having seizures, and was in and out of the hospital.

My romantic partner left me in mid-2003, taking our infant son with her. I cannot blame her—she was a young, first-time mom, and the prospect of being suddenly burdened with two children instead of just one was perhaps overwhelming. For all she knew, the non-stop seizures were going to render me catatonic, a basketcase. Thus, I was alone to deal with the seizures, adding to everything the pain of relationship break-down and the stress and humiliation of being allowed only irregular, supervised visits with my young son (lest I have a seizure, get knocked out, and he be stranded and helpless). During this time, I still couldn’t drive—and I live in a part of the world where this is quite inconvenient. The only saving grace of this terrible time was that I was able to hold on to my job, and even enjoy considerable success as a professor, especially in terms of teaching and publishing. My colleagues supported me, accommodated my scheduling needs, and even dragged me off the floor and/or called 9–1–1 after my latest classroom grand mal. (I even once had a cop come to my rescue in class, as he was the closest emergency official; and then, the next week, the students told me they thought it was so cool that I was the only professor they’d ever had, or heard of, who actually had his lecture interrupted by a uniformed police officer.)

As stated, this went on for years: about three or four, to be exact. The cumulative toll of all these experiences left me profoundly unhappy, and with little prospect for substantial improvement. I knew I had to do something, or be mired in this quicksand of suffering indefinitely. So, I resolved to do two things: 1) get to the bottom of the cause behind my epilepsy, once and for all; and 2) learn all I could about happiness in general, and what I could do to augment it in my life. I wish I could tell you that this ultra-nerdy second point is completely fabricated. Alas, it is not. As a professor, knowledge is and has been one of the most positive, inspiring, and motivating forces in my life. It was only natural that, if I felt I didn’t know something—something that was hurting me—I needed to turn that around and learn everything I could about it, and put what I learned into action. I’ve been told that this is a systematic approach to happiness—I suppose this is a polite way of putting it.

In comparison with some of the gruesome stuff I’d had to research regarding human rights violations and wartime atrocities—my two primary areas of expertise—getting to read about happiness in my spare time was an absolute joy. One of the first things that leapt out at me from the happiness literature was the need to widen and deepen social bonds. I knew I had let the epilepsy isolate me quite radically (apart from work-related socialization, I had next-to-no contact with others at the time) and I had to, and needed to, do much better in this regard. So, I started dating again, and socializing more broadly, and my happiness improved.

More on that later. For now, let’s return to the issue of discovering the cause behind the seizures. By this time, around 2005, I was on Neurologist Number Nine. Like the others, all he could do was prescribe drugs that were supposed to curtail the consequences of the seizures. But, unlike the others, he admitted that something just didn’t add up. If the seizures truly were cardiac in nature, then that cause—after all the experiments, procedures, and testing—really should have been discovered by now. I even remember the exact unsure and agitated look on his face when he said to me, You know, I went to medical school with a guy who’s since become probably the best epilepsy researcher around. I’m going to call him personally and ask him to see you. And I think you should just stop seeing heart specialists now. And then he washed his hands of me, as had all the others.

That’s how I got to see the specialist who would change my life. Let’s call him Omar. Omar was an immigrant to Canada from Saudi Arabia, and brought with him an enormous work ethic and strict sense of professionalism. Around forty years old, he already had a respected practice of treating epileptics in the region. I still remember the first time I visited the hospital floor where he had his clinic: the rooms and beds were filled with some of the most distressed and fractured people I’d ever seen. Moaning loudly, without hope. Writhing in pain and discomfort. Shaking with near-constant, low-level convulsions and seizures. And one very elderly lady, nearly catatonic, staring fixedly into space—not one glimmer of human awareness about her, mouth open, her little pink tongue darting in and out non-stop. If Omar could treat such people, I assumed he could at least help me.

At our first meeting, he patiently listened to my whole story, and the long list of medical theories and practitioners I’d burned my way through. He examined me physically. Then, in wrapping up, he said, We’re going to begin at the very start and assume nothing. We’re going to test you for everything once more, and I’m going to get my hands on that very first brain MRI they did on you back in 2001. We’ll do another fresh one, and compare the two tests. I booked my follow-up appointment and looked forward to it.

When I arrived for my second meeting a few months later, the receptionist told me that Omar was waiting for me—was this a first in all medical history, a doctor waiting on a patient?—and that he needed to see me in a different office, outfitted with special computer screens. Fine by me, I replied. Oh, she continued, and would you mind if several medical students and young interns attend the first part of the meeting? That caught my attention. Sure, I said. When I entered the office, there was a group of four young doctors-in-training, all standing behind Omar and staring at the huge wrap-around screen. They nervously glanced between their feet and me; I felt like a guinea pig on display. Omar looked stressed and focused. I know now why he had asked the young doctors to attend: it was a great teachable moment for them. They could see some cool medical images and relevant evidence, and then watch a doctor deliver some bad news to a patient and observe how the patient reacts when he finds out he’s been truly fucked over.

Omar began: You know how we just did that latest MRI on your brain last week, Brian? Of course—my memory’s not that bad. Well, he said seriously, it found something. Immediately, and without seeing, I knew it was a brain tumour—what else could it be? The news came as absolutely no surprise: there are only so many things, after all, which can cause repeated seizures. He invited me to come around to the front of the screen, and there I saw an amazingly clear portrait of my big, fat, beautiful brain, all clear and grey and gnarly and complex—except for that big patch of a neon-bright white down around my brain stem (like an errant piece of blackboard chalk). I actually felt relief: after all these years, I finally knew for sure.

But what happened next actually did surprise me, and quickly ended whatever relief I’d felt. Omar looked me straight in the eyes, with purpose, and pursed his lips. Let me show you something further, and put it side-by-side with last week’s image. The screen then divided in two, with the image I just saw now on the left, and a new image popping up over on the right. It was an older image, black and white, but still obviously the same brain—my brain—and … featuring the exact same chunk of bright white chalk, standing out like a supernova amidst the plain greyness of the rest of my brain.

This was the very first MRI they took of your brain, after your first seizure back in 2001. Two weeks after your first grand mal. I got the old film sent over just last week. There’s good news about this, and bad. The good news, as you can see, is that the tumour seems quite stable, and shows very little if any sign of growth. This means that it’s probably benign, and thus not life threatening, though we’ll need to do more tests to determine that for sure. Plus, this is probably what’s causing your seizures, though there, too, we’ll need to do tests—immediately—to prove this.

And the bad news?

The bad news is that, as you can see, the original image of your brain tumour is crystal clear. A child could have seen this. Yet no one reported this to anyone. This would seem to violate all kinds of proper medical practice. Brian, you actually may want to think about talking to a lawyer. You can have this image, and I’m going to get every MRI image that’s been done on your brain over the years. You can tell your lawyer that I’ll talk to him, and may be willing to serve as a witness. This failure to report the tumour might be medical negligence. I have thousands of patients who rely on the correct reporting of such images, and I can tell you that doctors totally depend on that for their treatment recommendations. I would very much want to see anyone found guilty of such to be charged and relieved of their duties. In my opinion, the only way they could have missed this tumour was if they never actually looked at the image at all.

I thanked the good doctor very much for discovering the truth, and for his offer of help, and stormed out of the hospital, fuming and cursing.

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Since then, I’m glad to report that my life has much improved. I’ve learned a ton from the happiness literature, having genuine fun along the way, and have implemented many of its recommendations into my life. I’m not perfectly happy—there’s no such thing—and there have been bumps in the road (even big ones), and today I have as many ups and downs in my daily mood as the next person. But I can say with 100 percent certainty that I’m much happier than I was back in that dark period of 2001–2005. I’ve gained much insight, both into human happiness in general and toward the special challenges faced by those with chronic conditions. My seizures, unlike in the early/mid-2000s, are no longer out of control. The proper diagnosis was the first step in being able to manage the condition more effectively. I got rid of all the heart medications, and through trial-and-error we discovered some epilepsy drugs that aided with seizure control. Plus, I made major lifestyle changes to help in this regard, involving rigorous daily exercise, good nutrition, and sound sleep hygiene. ¹¹ My brain tumour remains stable, I’m pleased to report, and I’ve been able to drive legally for some time now. I have a decent relationship with my now-teenage son, and see him at least twice a week. We’ve even visited the Grand Canyon, New York City, and Disney World together. I’ve been in some loving relationships with great women over the years. My job is as rewarding as ever, and I’ve been promoted as high as I can be in the professorial ranks. Some of my books (especially those on war) are used as required textbooks at colleges and universities around the world. I take nice trips a few times a year, usually in connection with some lucky and generous invitation to come lecture about something, whether in Italy, Sweden, France, or Greece, or closer to home in Arizona, California, Colorado, or New York.

But what of the MRI images? Well, I did indeed consult lawyers specializing in medical negligence. They confirmed that mine was almost certainly such a case. They even laughed at how glaring it was, agreeing with Omar that the only way the doctors and technicians could have missed the tumour in the original photo was if they failed to look at the MRI at all. So, did I sue everyone in sight—the doctor, the technicians, the very hospital where I was born? I wanted to, but didn’t. Why not? It was explained to me that, though my case was almost a slam dunk, the reality was that to prove such would take years of my life and cost tens of thousands of dollars. This, I was told, is because the professional association that represents doctors—as a matter of policy—pays the very best lawyers in the country a ton of money every year to contest, vigorously, every single alleged instance of medical negligence, no matter how obvious the guilt. I was looking at an enormous up-hill battle.

Closure came during a revealing meeting with a celebrated lawyer, who said, It’s clearly medical negligence, Brian. But your other lawyers are right: it’ll take you years to prove even so clear-cut a case. Plus, let me ask you something: How is your life now? Really quite good, actually. I cited some of the improvements listed above.

Bam! he shouted, while shooting his finger at me like a revolver. Bam! Right there. On the witness stand in court, right there, you just lost your case.

I looked at him with disbelief.

Brian, you have to understand. I’m a personal injury lawyer. The people I represent have been horribly injured in things like car accidents. I’m used to representing people so damaged that they have to use their tongues to drag their wheelchairs into court because that’s the only body part they’ve got left working! For people like that, I can get millions. Their lives have been destroyed by the actions of others. But you? You’ve just said that your life is actually better now; as a result, you can forget any hope of getting any money.

I was livid: "But all those improvements came about as a result of my own efforts—my own hard work at improving my life and overcoming the consequences of the negligence and the misdiagnosis. They happened in spite of the negligence and all the costs it imposed on me and those around me!"

I know, he said calmly. And good for you. But, lemme tell you, that’s your reward. This new life you’ve created for yourself. That’s your reward. No court is going to give you any money; there will, at best, only be the moral victory of a declaration of negligence. Is such a result worth years of your life, a ton of legal struggle, and tens of thousands of dollars? My advice to you is to let it go, and to enjoy this new life you’ve made.

So I did.

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The rest of this book, therefore, is a summation of my scholarly research and my own private life experience—over ten years of both—into human happiness, and how general advice about happiness needs to accommodate and consider the special needs of those with chronic conditions. I hope it can speak meaningfully to you, and offer both knowledge and advice that you can use to augment your own well-being and enjoyment of life. After all, as Tal Ben-Shahar says in his handy book Happier, ¹² we might not know everything about happiness, and we might not be able to get every element of happiness into our lives to a complete and perfect degree. But what we certainly can do—all of us, even those confronting challenges—is to make use of the best advice available, tailor it to our circumstances, and make ourselves measurably and sustainably happier. A better life, for each of us, awaits.

* Some fine print on definitions: throughout, I’ll mainly use the terms afflicted or those with chronic conditions to describe the group I have in mind, in contrast to the unafflicted. I have chosen these terms both to be moderate and to have a very broad umbrella of reference. Other terms are perhaps more frequently used, such as sick vs. healthy, abnormal vs. normal, disabled vs. abled, etc. On the one hand, I’ve no intention whatsoever of offending anyone, and everyone has the right to their own preferred self-description. On the other, these terms are contested, and can be interpreted in various ways by both insiders (part of the afflicted community) and others. We see similar debates within other communities about preferred labels: whether certain terms are offensive or okay, or even empowering. Such a debate over definitions is part of the subject. Generally, what I have in mind is the contrast between those of average functional human capacity vs. those whose functioning is, in some respect, chronically hampered. And such hampering or dysfunctionality, or below-average-capacity, isn’t merely imagined or socially constructed: it has a factual basis, and I believe that this needs not only to be admitted and owned but seen as a necessary condition for appealing for special treatment or accommodation by others and institutions, and indeed for progress toward improved personal happiness.

1

Happiness in General, and Pleasure in Particular

CHAPTER 1

Can Happiness Actually be Pursued?

Almost everything said in the Introduction is based on the premise that happiness is the sort of thing that can be pursued: that through knowledge, effort, and will we can actually make ourselves measurably happier. So much Western thinking and writing about happiness makes this basic assumption: that it’s possible to